The Australian government's recent rescheduling of psilocybin and MDMA for limited clinical use has raised regulatory challenges for psychedelic-assisted therapy. Through a desktop review, interviews with experts, and framework analysis, researchers developed a taxonomy of regulatory matters across six domains. Three domains—Service Establishment, Practitioner, and Treatment Delivery—contain many matters with uncertainty or conflicting views, such as where services should be located and which professionals qualify as therapists. The remaining domains—Patient Evaluation, Drug Supply, and Service Oversight—are relatively settled, with established regulation or consensus that regulation is unnecessary. The taxonomy offers a roadmap for health services and policymakers.
Innovative psychiatric treatments like ketamine therapy are emerging, but their resource-intensive nature makes them largely available only in the costly private sector, widening mental health inequity for those who cannot afford them. The Royal Prince Alfred Hospital's Ketamine Treatment Clinic, Australia's first public-sector clinic for complex mood disorders, offers a model. Based on three years of experience, the authors review the progress, perils, and pitfalls for clinicians and health services considering establishing a public-sector ketamine treatment service.